PDT modalities in the thorax for the Kaposiform hemangioendotheliomas with Kassabach Merriot syndrome.
Tashkent medical Adacemy, Tashkent, Uzbekistan.
OBJECTIVE: The vascular anomalies are the most frequent pathology in childhood. Vascular anomalies include different types of pathology- vascular tumor and vascular malformations. In rare cases can be noted Kaposiform hemangioendoteliomas, sometimes with Kassabach Merriot syndrome. Such cases make difficulties in the surgical approach for the bleeding complication. For this reason development of laser technologies as PDT is helpful.
METHODS: This research includes a 5 patient with Kaposiform hemangioendoteliomas on the thorax region. After general investigation was performed PDT procedure. For the PDT we used AFT-1 (Uzbekistan ) device with power 5W. Before the treatment we perform 5-ala local injection 1mg/ml after 3 hour exposition was done irradiation with 635 laser light 50J/cm2. PDT procedure was queued with ultrasound control during session and every month.
RESULTS: In a time of treatment by two out five patients who presented with long-term pain reported improvement after treatment. Also, 4/5 reported significant reduction of bleeding related to their hemangioendothelioma. Improvement of swelling was reported by 5/5 patients. Clinical assessment showed that PDT showed 'good response' to the treatment. Radiological and ultrasound assessment comparing imaging 6-week post-laser and PDT to the baseline showed significant response in 5 patients.
CONCLUSIONS: The management of kaposiform hemangiowndoteliomas continue to be extremely challenging. Although several modalities have been developed and the literature reports successful treatment in many, data from long term studies reports relapse in many and the need for re-treatment or another intervention. Photodynamic therapy is not superior to other modalities, but it is characterised by being one of the least invasive, being repeatable with no residual toxicity and with a minimal bystander effect on the overall tissue architect and integrity as well as nerves.
The growing body of evidence regarding its efficacy, the increasing use of image guided PDT, and the innate minimally invasive characteristics of PDT suggest that it should become an important addition to the various techniques used in the management of vascular anomalies
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